As modern battlefield preparations have shifted towards a focus on conflict against peer and near-peer adversaries, large-scale combat operations (LSCO) present challenges to casualty care on a scale not experienced since World War II. Medical evacuation capabilities are anticipated to be episodic. Prolonged casualty care will require massive consumption of far-forward medical resources and healthcare personnel, however, likely without access to protected medical facilities. LSCO will generate mass casualty events (MCE) requiring methods for triage to provide medical care for the “greatest good.” Blood product availability will continue to be a critical life-saving intervention as well as a constraint in an operational environment without prolific damage control surgical capability. Past and present experiences with LSCO combined with predicted future LSCO scenarios will challenge the feasibility and effectiveness of massive casualty response, triage, evacuation, logistics, surgical damage control, and hospitalization which will likely require the integration of civilian surgeons and trauma systems. In this paper, we will analyze challenges and discuss potential solutions to combat casualty care in modern LSCO.